Provider Demographics
NPI:1194150938
Name:JOHNSON, VANESSA DENISE (RN, CLS, DOULA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:DENISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, CLS, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 N 91ST ST UNIT 250592
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-7019
Mailing Address - Country:US
Mailing Address - Phone:414-768-2268
Mailing Address - Fax:
Practice Address - Street 1:3418 N 50TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216
Practice Address - Country:US
Practice Address - Phone:414-768-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI374J00000X
WI153476-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374J00000XNursing Service Related ProvidersDoula